What’s Hot in Clots – May 2023

Key Updates in Thrombosis

Table of Contents

1. Downregulation of HSP47 as the BEAR minimum to prevent thrombosis during hibernation: Lessons for humans?
2. Prothrombin complex concentrate in trauma patients to reduce massive transfusions: How about no?
3. Apixaban is unnecessary in outpatients with COVID-19: ACTIV-4C
4. Compression stockings and durable DVT symptoms: Do they work or not?

Downregulation of HSP47 as the BEAR minimum to prevent thrombosis during hibernation: Lessons for humans?

In an interesting study, a multidisciplinary group of authors noticed that a reduction in heat shock protein 47 (HSP47) is the most likely explanation for lack of thrombosis in hibernating bears. In complementary analyses, they recognized that mice lacking HSP47 had fewer clots. The two relevant clinical questions are:  1. After how long does the risk of immobility-associated venous thrombosis go down? And 2. Could HSP47 be a target for treatment? Read more

Prothrombin complex concentrate in trauma patients to reduce massive transfusions: How about no?

In a randomized trial from 12 French trauma centers, patients with trauma deemed at high risk for massive transfusions were randomized to 4-factor prothrombin complex concentrate (4F-PCC) or placebo. The study intervention did not lead to a clinically relevant or statistically significant reduction in the 24-hour use of blood products but led to a significant increase in thrombotic events, with a whopping 11% increase in absolute risk (from 24% in patients receiving placebo to 35% in those receiving 4F-PCC). Read more

Apixaban is unnecessary in outpatients with COVID-19: ACTIV-4C

We discussed the results of the PREVENT-HD trial of rivaroxaban during our coverage of AHA 2022. Now the investigators have shared the results of the NIH-sponsored ACTIV-4C trial of low-intensity apixaban vs placebo in outpatients with COVID-19. In short, the findings are similar. Adverse event rates are low and apixaban does not confer additional benefit. Read more

Compression stockings and durable DVT symptoms: Do they work or not?

Whether patients with DVT “need to” put on compression wearables has been widely debated. Some argue that these wearables help the patients feel better, while others quote large trials such as SOX to recommend against compression stockings. However, a recent meta-analysis of randomized trials, including SOX, re-ignites the debate by showing a reduction in the subsequent rate of post-thrombotic syndrome. Read more

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